Naughton Matthew T
General Respiratory and Sleep Medicine, Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne, Victoria 3004, Australia.
Crit Care Clin. 2008 Jul;24(3):565-87, vii-viii. doi: 10.1016/j.ccc.2008.02.004.
Ventilation during sleep is under tight metabolic control, and can be destabilized by upper airway obstruction leading to snoring or obstructive apneas, inadequate respiratory pump muscle activity leading to hypoventilation, and central control instability leading to changes in metabolic feedback and loop gain. These three physiologic disturbances can lead to obstructive sleep apnea hypopnea syndrome (OSAHS), hypoventilation syndromes, and periodic breathing. OSAHS places a strain on the cardiac output by virtue of hypoxemia, large negative intrathoracic pressures, and high swings in systemic blood pressure. Periodic breathing, also known as central sleep apnea with Cheyne-Stokes pattern of respiration, is likely to be a product of advanced heart failure.
睡眠期间的通气受到严格的代谢控制，上气道阻塞（导致打鼾或阻塞性呼吸暂停）、呼吸泵肌肉活动不足（导致通气不足）以及中枢控制不稳定（导致代谢反馈和环路增益变化）都可能使其不稳定。这三种生理紊乱可导致阻塞性睡眠呼吸暂停低通气综合征（OSAHS）、通气不足综合征和周期性呼吸。OSAHS由于低氧血症、巨大的胸内负压和全身血压的大幅波动，会给心输出量带来负担。周期性呼吸，也称为伴有陈-施呼吸模式的中枢性睡眠呼吸暂停，很可能是晚期心力衰竭的产物。
